| NPI | 1659696425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: CT 054311) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 263739) |
| Enumeration Date | 2010-04-05 |
| Last Update Date | 2017-11-29 |